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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Provider Reimbursements from the Exchange?

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Question: How will healthcare providers be reimbursed by the CA Exchange?

Answer: California healthcare providers will continue to be reimbursed directly form the insurance carriers as they are now. However, you can look for some improvements once the Exchange is operational. The behavior of insurance companies that offer qualified health plans through the exchange will be more transparent and they can be held accountable for short-comings such a delays or denials of provider reimbursements as a condition of their continued participation in the Exchange. The exchange can also make available information to providers as well as consumers about how different health insurance plans perform on measures such as prompt payment of claims, customer service, breadth and quality of plan provider networks, and outcomes of grievance and appeals processes.

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Will the “metal” plans reimburse same amounts to providers whether they are thru the exchange or thru the insurance company directly????????

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